程正亮

(安康市中医医院骨一科，陕西 安康　725000)



胸腰段椎体骨折脱位伴脊髓损伤不同手术时机治疗的疗效比较

程正亮

(安康市中医医院骨一科，陕西 安康725000)

目的：探讨胸腰段椎体骨折脱位伴脊髓损伤的手术时机选择及疗效观察。方法：将本院收治的90例胸腰段椎体骨折脱位伴脊髓损伤患者根据接受手术治疗的时间分为两组，A组于伤后72 h内接受手术治疗，共54例；B组于伤后72 h后接受手术治疗，共36例。两组均采取经后路减压椎弓根钉棒内固定术治疗。比较两组患者手术时间、术中出血量及治疗前后脊髓损伤Frankel分级、椎管容积、伤椎前缘高度、伤椎后缘高度、Cobb角变化情况。结果：A组手术时间、术中出血量均明显多于B组(P<0.01)；两组患者术后椎管占位、伤椎高度、Cobb角均较术前有明显改善(P<0.01)，两组术后比较无统计学差异(P>0.05)；A组术后脊髓损伤Frankel分级有明显改善(P<0.05)，B组无明显改善(P>0.05)。结论：胸腰段椎体骨折脱位伴脊髓损伤患者早期行手术治疗可有效解除压迫，促进脊髓功能恢复，但也应考虑到手术时间与术中出血量，综合权衡利弊。

胸腰段椎体骨折脱位；脊髓损伤；手术时机；脊髓功能恢复

【Abstract】Objective：To discuss the surgical timing and curative effect of thoracolumbar fracture dislocation with spinal cord injury.Methods：90 cases of patients with thoracolumbar fracture dislocation and spinal cord injury in our hospital were divided into two groups according to the surgical time.Group A was treated with surgical treatment in patients after injury,there was a total of 54 cases;Group B received surgical treatment 72 h after injury,there was a total of 36 cases.The two groups were treated by posterior decompression and pedicle screw rod internal fixation treatment.The operation time,bleeding volume and Frankel grade of spinal cord injury before and after treatment,spinal canal volume,injured vertebral height,injured vertebral rear height,Cobb angle changes were compared between two groups.Results：The operation time,bleeding volume of operation of group A were significantly higher than those of group B (P<0.01);Postoperative vertebral placeholder,injured vertebral height,Cobb angle after surgery of two groups were significantly improved than those before surgery (P<0.01)，there were no statistical differences in comparison between two groups after surgery(P>0.05);There was significant improvement in Frankel grade of spinal cord injury of group A after surgery(P<0.05),there was no significant improvement in group B (P>0.05).Conclusion：For patients with thoracolumbar fracture dislocation with spinal cord injury,early operative treatment can effectively relieve the oppression,and promote functional recovery of spinal cord,but it should also take into account the amount of bleeding,operation time and intraoperative comprehensive balance.

胸腰段椎体骨折脱位是临床常见的脊柱外伤，大多患者是由于垂直压缩暴力所致，骨折后骨块突入椎管中可使脊髓受到压迫，进而引发脊髓神经损伤[1-2]。对于胸腰段椎体骨折脱位伴脊髓损伤患者而言，手术是绝对适应症，而椎弓根钉棒系统具有的三维空间复位及短节段固定优点，被认为是目前理想的脊柱内固定治疗手段[3]。目前针对部分严重损伤患者在手术时机的选择上尚存在争议，但若能及早恢复椎管容积，重建脊柱稳定性对术后神经功能的恢复具有重要意义[4]。……